Thrombolysis in young adults with ischemic stroke

No exclusive systematic data exist on the safety and outcomes of thrombolytic treatment in young patients with ischemic stroke.

We evaluated all 48 patients aged 16 to 49 years with hemispheric ischemic stroke treated with intravenous alteplase in Helsinki University Central Hospital from 1994 to 2007. For comparison of outcome, we selected, blinded to outcome data, 96 control subjects (1:2) with ischemic stroke not treated with alteplase matched by age, gender, and admission stroke severity (National Institutes of Health Stroke Scale). We selected similarly 96 older alteplase-treated gender and arrival National Institutes of Health Stroke Scale score-matched patients (aged, 50 to 79 years) for comparison of outcome and hemorrhage rate. A 3-month favorable outcome was defined as modified Rankin Scale score of 0 to 1. Symptomatic intracerebral hemorrhage was defined according to the Safe Implementation of Thrombolysis in Stroke Monitor Study.

Young alteplase-treated patients (67% males; mean age, 38.8+/-9.1 years) more often recovered completely (27% versus 10%, P=0.010) and achieved a favorable outcome (40% versus 22%, P=0.025) compared with their age-matched control subjects not treated with alteplase. In alteplase-treated patients, unfavorable outcome was more frequent in males and in those with carotid artery dissection. We observed no difference in outcome between cases and older control subjects treated with alteplase. However, none of the cases had symptomatic intracerebral hemorrhage versus 3 (3%) in the older control group (P=0.551). Mortality rate was 2% (P=0.552) in age-matched control subjects and 7% (P=0.095) among older control subjects, whereas none of the case patients died during the 3-month follow-up.

Young adults with acute hemispheric ischemic stroke benefited from intravenous thrombolysis with good safety.